Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A24525 | CA |
NPI | 1043227242 |
---|---|
Provider Name | Dr. Melvin Alan Butler |
First Address | Santa Monica, CA 90403 |
Second Address | Santa Monica, CA 90403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A24525 | (02) |